Active NPI
Charles Dana Brack, PT
- Physical Therapist
- Tucson, AZ
National Provider Identifier
1982650693
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1026
- Practice address
- 4544 E Camp Lowell Dr
Suite 150
Tucson, AZ 85712-1282 - Phone
- (520) 884-0001
- Fax
- (520) 884-0199
- NPI assigned
- May 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1026 | AZ | Primary |
Addresses
Primary practice location
4544 E Camp Lowell Dr
Suite 150
Tucson, AZ 85712-1282
Mailing address
4884 N Louis River Way
Tucson, AZ 85718-4755
Phone (520) 797-7813
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00713739 | Other | AZ | RAILROAD MEDICARE PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1026 | AZ | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1248307200000",
"number": "1982650693",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4884 N LOUIS RIVER WAY",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857184755",
"telephone_number": "520-797-7813"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4544 E CAMP LOWELL DR",
"address_2": "SUITE 150",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857121282",
"telephone_number": "520-884-0001",
"fax_number": "520-884-0199"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRACK",
"first_name": "CHARLES",
"middle_name": "DANA",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-25",
"last_updated": "2009-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AZ",
"license": "1026",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE PTAN",
"identifier": "P00713739",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.